腹腔镜肾上腺巨大肿瘤切除术临床分析

目的:探讨腹腔镜肾上腺巨大肿瘤切除术的临床可行性及意义。方法:应用经腹腔途径为45例肾上腺肿瘤患者行腹腔镜肾上腺肿瘤切除术。术前均经B超、CT或MRI等相关影像学检查初步确诊。45例患者分为2组,32例肾上腺肿瘤直径5cm(A组),13例肿瘤直径5cm(B组)。观察2组患者手术时间、术中出血量、住院时间、中转开放率及围手术期并发症等情况。术后常规随访,定期行B超及胸片检查。结果:45例均顺利完成腹腔镜手术,平均手术时间(A组58.6min,B组86.7min)、术中平均出血(A组31.6ml,B组84.3ml)两组差异均有统计学意义(P0.01);中转开放手术A组3例(9%),B组1例(8%),两组差异无统计学意义(P0.05)。B组术中1例需输血;术后平均住院A组5.2d,B组5.7d,两组差异无统计学意义(P0.05)。术后患者均顺利康复。结论:与腹腔镜较小肾上腺肿瘤(5cm)切除术相比,腹腔镜巨大肾上腺肿瘤(5cm)切除术手术时间长,术中出血多,但住院时间及围手术期并发症无显著差异。只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行。

The clinical analysis of laparoscopic tumorectomy for large adrenal gland neoplasms

Objective:To approach the clinical feasibility and the significance of laparoscopic tumorectomy for large adrenal gland neoplasms.Methods:All the 45 patients with adrenal tumor underwent laparoscopic tumorectomy for adrenal gland neoplasms through 70° recumbent position.All the cases were initially diagnosed through B-US,CT or MRI.The patients were divided into two groups based on tumor size:<5cm(n=32,group A) and >5cm (n=13,group B).The operative time,blood loss during surgery,hospital stay,conversion to open surgery rate,and perioperative complications of 2 groups were observed.During routing follow up after operation,B-US and chest film was periodically inspected.Results:All operations were finished successfully.Mean operative times were 58.6min and 86.7min for groups A and B,respectively.Mean estimated blood loss was 31.6ml for group A and 84.3ml for group B.Operative time and blood loss were significantly more in group B(P<0.01).3 cases were converted to open surgery in group A(9%),and 1 cases was converted to open surgery in group B(8%);1 case needed blood transfusion in group B; Mean postoperative hospital stay was 5.2d and 5.7d for group A and B; No significant difference was found between the 2 groups concerning transfusion rates,hospital stay,and conversion to open surgery rate(P>0.05).All the cases recuperated successfully.Conclusions:Laparoscopic adrenalectomy is a feasible procedure for large masses(>5cm) but results in longer operative time and more blood loss when compared with results for masses smaller than 5cm.Our findings suggest,however,that laparoscopic adrenalectomy for masses larger than 5cm can produce comparable results concerning hospital stay,conversion to open surgery rate,intraoperative and postoperative complications in comparison with results for adrenal masses smaller than 5cm.The laparoscopic adrenalectomy for large adrenal masses is feasible if the surgical operator is skillful in the laparoscopic procedure and has sufficient clinical experience.